What Makes You SAD?

You're probably wondering why I capitalized 'SAD' in the title above. It's because while I would love to talk about sadness in general, today I'm writing about Seasonal Affective Disorder. In the wake of the time change this past weekend, I found myself thinking about how the patterns of darkness and light affect a portion of the world's population.

Seasonal Affective Disorder, or Major Depressive Disorder with Seasonal Pattern (as it's known in the DSM-5, the diagnostic manual therapists use) occurs in four times as many women as it does men, and disproportionately affects people who live further from the equator. Unbeknownst to many, there are two major patterns of SAD, with one being the 'winter blues,' which is more commonly spoken about, and the other is labeled 'summer seasonal pattern disorder.'

The winter pattern of SAD is marked by sad mood, low energy, frequent bouts of crying, withdrawal from social situations, cravings for carbohydrates and sugars, subsequent weight gain, and possibly suicidal thoughts. People who experience the winter blues typically have higher levels of melatonin and trouble regulating their serotonin levels due to increased SERT proteins. You can read more about that here. Vitamin D levels are naturally lower in the winter due to people spending less time outside. Circadian rhythms, our pattern of sleep and waking, are changed in the fall and winter as sunlight becomes scarce. We find that people hibernate during the winter slightly, much like animals do, probably to the detriment of our health. All of these factors are believed to be part of the cause for SAD for the general population.

Symptoms for the 'summer seasonal pattern' of Seasonal Affective Disorder are poor appetite leading to weight loss, insomnia, agitation, restlessness and anxiety. This pattern of SAD is less common, but may give answers to some clients who find that they struggle in the summer especially. Given that we are headed towards winter, the focus of today's post will be on how to manage the winter pattern of SAD in the coming months.

Treatment for Seasonal Affective Disorder may involve an antidepressant prescription (I know of people who obtain a prescription every fall in preparation), light therapy, Vitamin D supplementation, and counseling. My recommendations to all clients who find their mood affected by the winter blues are as follows:

• Find small ways to obtain and sustain joy. Buy a new candle. Decorate early for the holidays. Tend to your houseplants. Get cozy blankets and build a fire in your fireplace. Hunkering down doesn't have to feel like drudgery.

• Go outside anyways. There is a saying that my family lives by: 'There is no such thing as bad weather, only inappropriate clothing.' We aim for an hour outside per day in the winter months, and 3 or more hours a day in the spring and summer. Research shows that bad weather is actually good for you.

• Eat good foods, move your body for 20 minutes per day purposefully, and get enough sleep.

• Set an alarm and wake up at the same time every day. Yes, even on the weekends.

• Remember that winter doesn't last forever, and your depression symptoms can be managed through counseling. Give me a call or email me if you want assistance with this step.

Seasonal affective disorder doesn't have to run your life this winter. You can feel better and do more, even when your mind and body want you to do less. Know that I'm rooting for you!

Take exquisite care of yourself and your family,

8 Ways to *Not* Support Your Friend Who Has Lost a Baby

Hello friends! One of my therapy specialties is supporting families grieving perinatal (miscarriage and stillbirth) and infant loss. This specialty is born out of my own story, one which I may share here someday. Most therapists work with what they know, and I know fertility struggles, miscarriage and infant loss intimately. I wish I didn't know this type of grief at all sometimes. Because I know this topic so well, I also know the not so helpful ways that people try to assist when a family is grieving the loss of their pregnancy or baby. Here is a list of 8 ways to *not* support your friend (or family member) who has lost a baby:

1. Poor Comfort Technique: "You can always have another." It's number one on this list for a reason. When people have just told you they have lost a pregnancy or a child, the last thing they want to hear is about the baby or babies they *might* get to carry in the future. Also, it's insensitive to those families that find achieving pregnancy difficult. Future children/pregnancies aren't guaranteed so short of you being able to see the future and interpret it accurately, just don't say this one at all.

2. Don't say this: "At least you're able to get pregnant." I heard this one at least once, and I have to say, not helpful. It was like, 'Yes, thank you for that. I have been pregnant five times and have one living child. That is not something I want to be reminded of when I am telling you my story.' And, at certain points in our family's story, I would have given anything not to experience pregnancy again because it meant possibly braving yet another loss, and I wasn't sure if my marriage or my heart could take it.

3. Please for the love of everything, don't say this: "Everyone has one." It's factually incorrect, and it's not a normalizing response, like you think it is. This response is trivializing a family's grief. And, even if everyone did experience a miscarriage, does that make their loss any less real? Does it matter any less?

4. Poor Comfort Technique: "There's always adoption." Oh dear, let's not start with problem solving as a listening technique. It never works the way it is intended. And, adoption is not part of every family's story, nor should it be. It is a special process that should be entered into with excitement, peace and joy, not suggested as a 'back up plan' for a family experiencing miscarriage, fertility or infant loss. Frankly, it's none of our business what each couple or family chooses in regards to growing their family. Our job, as a loving family member or friend, is to offer support and happiness, no matter how their family comes to be!

5. Giving weird gifts. This one is hard for people. Hearing about babies dying or miscarriages throws people into a tailspin. 'Babies aren't supposed to die.' So, what do people do when they have no words? They buy gifts, some of which have no business being bought, and some of which send the wrong message no matter how thoughtful the giver was in selecting it.

6. Forgetting to inquire about mom's physical health after suffering a miscarriage or pregnancy loss. Pregnancy is hard on the female body, and most miscarriages are painful and women are often unprepared for this level of pain. Asking the mom how she is feeling and if there is anything we can do to support her physical healing is key.

7. Not respecting family/maternity leave after the loss. If a friend, coworker or family member is taking time off work after a miscarriage, stillbirth or pregnancy loss, give them that time. They need it to physically heal, hold their cracked hearts and be with their main supports. Family leave should be granted to any family suffering such a loss, but it is often not. Advocate for it, if you are a supervisor at a company or an agency. Advocacy brings about change.

8. Bringing up your own loss. Remember, the key to listening is to just be present. If your friend or family member asks you about your experience, then that is your cue to share, but otherwise, it is best to not bring up your grief/loss. Empathy is sitting with people in their pain. Sympathy is looking down on people and saying, "Whew! It looks bad down there. Let me tell you about a time it was worse for me..."

Since this blog is also about helping, here are 4 ways to support your friend through this period of grief:

1. Offer to help in tangible ways. Ask to bring a meal/start a meal train. Inquire if a cleaning service would be helpful. Ask them to make you a list of chores and a time you can come by and help. Offer to watch their other children if they have them so they can rest.

2. If you choose to send a gift, ask the family what would be meaningful to them. Tailor it to their belief system around the afterlife and make it tasteful. A great example of this is that a family member of ours asked us if a religious statue for our garden would be welcome and then sent us a link so we could select our own. It was delivered within two weeks. I still look at that statue and smile.

3. Ask about their baby. Ask about their experience. People want to know that you remember their baby, that you hear them and see their anguish.

4. Listen. Deeply. Listen to understand by asking thoughtful questions, and then prepare yourself to listen more than once, as grief often comes in waves. Give them the gift of your time and patience throughout this process.

Know that all of us have flubbed up in this arena at least once. It's hard to know what to say or do when someone tells you they've lost a pregnancy or that their baby has died. Hopefully this post can serve as a guide in the future.

And if you've suffered loss, know that I am holding you in my heart, right next to my love for my sweet babies that I believe are in Heaven.

Take care of yourself,

Book Review: 'Maybe You Should Talk to Someone'

Good Monday Morning! Today, I thought we should kick off with a book review. Some of you may know that I co-lead a therapist book club, and I LOVE reading. Anything really. For fluff, I read suspense, mystery, or romance novels. For work, I read books written by therapists. In the therapy room, I assign books sometimes as 'homework' for my clients. Bibliotherapy is highly effective and highly under-utilized by therapists and clients alike. Here's a link to a study about bibliotherapy if you're interested in its efficacy in improving mental health symptoms, specifically anxiety or depression. Since I want my blog to be a useful place for clients and people who otherwise may not be able to afford therapy, I thought I would give you a few book reviews to help jumpstart your 'To Be Read' list.

'Maybe You Should Talk to Someone' by Lori Gottlieb holds a special place in my heart. It's a memoir of Lori's experience with an existential crisis in her thirties and forties, and how she navigates attending therapy for herself while holding space for her clients. It is, hands down, the best book I have read about psychotherapy in a long time. It's funny, it's real, it's warm. Her stories and her clients' stories shine through each page as a beacon of hope for all of us.

To give you some context, I would like to set the stage of where my life was when I read this book. In the year prior to me picking up this book, my first daughter had died of a congenital birth defect and was stillborn. I was navigating fertility issues, recurrent miscarriages, and the heaviness of grief in my marriage, which was still very young and untested. I'm not certain how I came across Lori's book, but from the moment I opened it up, I felt like she was speaking to me.

Lori tackles everything in this book: grief, trauma, broken relationships, love, sex, cancer, death. You name it, and somehow she has managed to share a client's story that resonates with that particular theme. She shows all of us her vulnerability in going to therapy for the *first time* as a therapist herself. Wendell, her therapist, is witty, warm and unpredictable. He helps her find herself again, and wrestle with her fears of dying.

My favorite quote in the whole book is this: "People tend to dream without doing, death remaining theoretical. We think we make bucket lists to ward off regret, but really they help us to ward off death. After all, the longer our bucket lists are, the more time we imagine we have left to accomplish everything on them. Cutting the list down, however, makes a tiny dent in our denial systems, forcing us to acknowledge a sobering truth: Life has a 100 percent mortality rate. Every single one of us will die, and most of us have no idea how or when it will happen. In fact, as each second passes, we're all in the process of coming closer to our eventual deaths. As the saying goes, none of us will get out of here alive."

When people ask me to recommend books about therapy, this is often my first pick. You will laugh, you will cry, and at the end, you will be grateful for the time you spent with this book open on your lap. You can purchase it here. Let me know what you think about the book in the comments below or send me an email. I'd love to discuss it further with you!